Note: Some Protocols contain images. You may click the thumbnails to preview the full image. To print Protocols with full size images, please add those Protocols to your Toolkit and Generate a Report.

Stroke Impact Scale (SIS) - Adults #820701

Protocol Release Date

July 30, 2015

Protocol Name From Source

This section will be completed when reviewed by an Expert Review Panel.

Description of Protocol

The Stroke Impact Scale (SIS) includes 59 proxy- or self-report items in 8 domains that assess multidimensional stroke outcomes. Items 1(a-d) measure strength. Items 2(a-g) measure memory and thinking. Items 3(a-I) measure emotions. Items 4(a-g) measure ease or difficulty of communication. Items 5(a-j) measure activities of daily living/instrumental activities of daily living (ADL/IADL). Items 6(a-I) measure mobility. Items 7(a-e) measure hand function. Items 8(a-h) measure participation/role function. Item responses are scored on a 5-point Likert-style scale. A score of 1 = an inability to complete the item and a score of 5 = no difficulty experienced at all. A standardized score ranging from 0 to 100 is calculated for all domains, with higher scores indicating a higher quality of life. An extra question on stroke recovery asks that the client rate on a scale from 0 to 100 how much the client feels that he/she has recovered from his/her stroke, where 0 = "no recovery" and 100 = "full recovery."

Specific Instructions

The Stroke Impact Scale (SIS) should be used with caution in individuals with mild impairment as the items in the Communication, Memory, and Emotion domains are considered easy and only capture limitations in the most impaired individuals.

Protocol

Stroke Impact Scale

VERSION 3.0

The purpose of this questionnaire is to evaluate how stroke has impacted your health and life. We want to know from YOUR POINT OF VIEW how stroke has affected you. We will ask you questions about impairments and disabilities caused by your stroke, as well as how stroke has affected your quality of life. Finally, we will ask you to rate how much you think you have recovered from your stroke.

These questions are about the physical problems which may have occurred as a result of your stroke.

1. In the past week, how would you rate the strength of your....

A lot of strength

Quite a bit of strength

Some strength

A little strength

No strength at all

a. Arm that was most affected by your stroke?

5

4

3

2

1

b. Grip of your hand that was most affected by your stroke?

5

4

3

2

1

c. Leg that was most affected by your stroke?

5

4

3

2

1

d. Foot/ankle that was most affected by your stroke?

5

4

3

2

1

These questions are about your memory and thinking.

2. In the past week, how difficult was it for you to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Extremely difficult

a. Remember things that people just told you?

5

4

3

2

1

b. Remember things that happened the day before?

5

4

3

2

1

c. Remember to do things (e.g. keep scheduled appointments or take medication)?

5

4

3

2

1

d. Remember the day of the week?

5

4

3

2

1

e. Concentrate?

5

4

3

2

1

f. Think quickly?

5

4

3

2

1

g. Solve everyday problems?

5

4

3

2

1

These questions are about how you feel, about changes in your mood and about your ability to control your emotions since your stroke.

3. In the past week, how often did you...

None of the time

A little of the time

Some of the time

Most of the time

All of the time

a. Feel sad?

5

4

3

2

1

b. Feel that there is nobody you are close to?

5

4

3

2

1

c. Feel that you are a burden to others?

5

4

3

2

1

d. Feel that you have nothing to look forward to?

5

4

3

2

1

e. Blame yourself for mistakes that you made?

5

4

3

2

1

f. Enjoy things as much as ever?

5

4

3

2

1

g. Feel quite nervous?

5

4

3

2

1

h. Feel that life is worth living?

5

4

3

2

1

i. Smile and laugh at least once a day?

5

4

3

2

1

The following questions are about your ability to communicate with other people, as well as your ability to understand what you read and what you hear in a conversation.

4. In the past week, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Extremely difficult

a. Say the name of someone who was in front of you?

5

4

3

2

1

b. Understand what was being said to you in a conversation?

5

4

3

2

1

c. Reply to questions?

5

4

3

2

1

d. Correctly name objects?

5

4

3

2

1

e. Participate in a conversation with a group of people?

5

4

3

2

1

f. Have a conversation on the telephone?

5

4

3

2

1

g. Call another person on the telephone, including selecting the correct phone number and dialing?

5

4

3

2

1

The following questions ask about activities you might do during a typical day.

5. In the past 2 weeks, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Cut your food with a knife and fork?

5

4

3

2

1

b. Dress the top part of your body?

5

4

3

2

1

c. Bathe yourself?

5

4

3

2

1

d. Clip your toenails?

5

4

3

2

1

e. Get to the toilet on time?

5

4

3

2

1

f. Control your bladder (not have an accident)?

5

4

3

2

1

g. Control your bowels (not have an accident)?

5

4

3

2

1

h. Do light household tasks/chores (e.g. dust, make a bed, take out garbage, do the dishes)?

5

4

3

2

1

i. Go shopping?

5

4

3

2

1

j. Do heavy household chores (e.g. vacuum, laundry or yard work)?

5

4

3

2

1

The following questions are about your ability to be mobile at home and in the community.

6. In the past 2 weeks, how difficult was it to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Stay sitting without losing your balance?

5

4

3

2

1

b. Stay standing without losing your balance?

5

4

3

2

1

c. Walk without losing your balance?

5

4

3

2

1

d. Move from a bed to a chair?

5

4

3

2

1

e. Walk one block?

5

4

3

2

1

f. Walk fast?

5

4

3

2

1

g. Climb one flight of stairs?

5

4

3

2

1

h. Climb several flights of stairs?

5

4

3

2

1

i. Get in and out of a car?

5

4

3

2

1

The following questions are about your ability to use your hand that was MOST AFFECTED by your stroke.

7. In the past 2 weeks, how difficult was it to use your hand that was most affected by your stroke to...

Not difficult at all

A little difficult

Somewhat difficult

Very difficult

Could not do at all

a. Carry heavy objects (e.g. bag of groceries)?

5

4

3

2

1

b. Turn a doorknob?

5

4

3

2

1

c. Open a can or jar?

5

4

3

2

1

d. Tie a shoe lace?

5

4

3

2

1

e. Pick up a dime?

5

4

3

2

1

The following questions are about how stroke has affected your ability to participate in the activities that you usually do, things that are meaningful to you and help you to find purpose in life.

8. During the past 4 weeks, how much of the time have you been limited in...

None of the time

A little of the time

Some of the time

Most of the time

All of the time

a. Your work (paid, voluntary or other)

5

4

3

2

1

b. Your social activities?

5

4

3

2

1

c. Quiet recreation (crafts, reading)?

5

4

3

2

1

d. Active recreation (sports, outings, travel)?

5

4

3

2

1

e. Your role as a family member and/or friend?

5

4

3

2

1

f. Your participation in spiritual or religious activities?

5

4

3

2

1

g. Your ability to control your life as you wish?

5

4

3

2

1

h. Your ability to help others?

5

4

3

2

1

9. Stroke Recovery

On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?

_______

100 Full Recovery

____

_______

90

____

_______

80

____

_______

70

____

_______

60

____

_______

50

____

_______

40

____

_______

30

____

_______

20

____

_______

10

____

_______

0 No Recovery

Scoring: Each item is rated in a 5-point Likert scale in terms of the difficulty the patient has experienced in completing each item. A score of 1 = an inability to complete the item and a score of 5 = no difficulty experienced at all. Summative scores are generated for each domain. Domain scores range from 0-100.

The Stroke Impact Scale (SIS) is scored in the following way, for each domain:

Three items in the emotion domain, 3f, 3h, and 3i, are reverse-scored, i.e., 1 becomes 5, 2 becomes 4, 3 remains the same, 4 becomes 2, and 5 becomes 1, prior to manual calculation. For these items, use the following equation to compute the individual’s score:

6 - individual’s rating = item score

The last item assesses the participant’s overall perception of recovery and is presented in the form of a visual analog scale from 0 to 100, where 0 = "no recovery" and 100 = "full recovery."

During the past 4 weeks, how much of the time have you been limited in your ability to help others?

4

N/A

PX820701_FunctionalityAfterStrokeAdult_Representing_Stroke_Recovery

PX820701090000

On a scale of 0 to 100, with 100 representing full recovery and 0 representing no recovery, how much have you recovered from your stroke?

4

N/A

Selection Rationale

The Stroke Impact Scale (SIS), Version 3.0 is a reliable and valid proxy- or self-administered questionnaire that is widely used to measure the quality of life in stroke survivors. In contrast to more generic quality of life instruments, the SIS is more sensitive to short-term changes in health status after a stroke.